Healthcare Provider Details

I. General information

NPI: 1013592971
Provider Name (Legal Business Name): ANDREA CAROLINA YEGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 540
MIAMI BEACH FL
33140-2842
US

IV. Provider business mailing address

4302 ALTON RD STE 540
MIAMI BEACH FL
33140-2842
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2499
  • Fax:
Mailing address:
  • Phone: 305-674-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME183149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: